Nations, businesses, volunteers battle AIDS epidemic in Africa

Milwaukee Journal Sentinel KAMPALA, Uganda _ Goats and chickens scatter as a dirt bike pings down rutted roads, past banana trees and sugar cane, to a village deep in the African bush. Its driver is delivering some of the world’s most advanced drugs to people in mud-and-thatch huts. Once a week he visits them, making sure they are following the complicated pill schedule. He brings something just as precious as the medicine in his backpack. He brings hope that Africa’s horrific AIDS epidemic can be turned back. Every day on the continent, 6,000 people die because they don’t get drugs that make AIDS survivable elsewhere. But that is changing. An unprecedented amount of money and effort is flowing into Africa as powerful people, businesses and nations try to end this calamity. President Bush is promising billions; Microsoft’s Bill Gates is giving millions; former President Clinton is negotiating cheaper drugs; and the World Health Organization is aiming to get them to 3 million people by the end of 2005. News of the epidemic in Africa dominated a recent U.S. AIDS conference normally devoted to domestic concerns. Africa also is doing more to help itself. South Africa’s government just pledged to get drugs to all who need them — a stunning reversal by leaders who for years had denied that a virus, HIV, even causes the disease. As a result of all these efforts, limited quantities of life-saving AIDS drugs are slowly becoming more available across the continent in what amounts to the biggest public health experiment in history. The drugs must be taken exactly as prescribed _ no sharing, splitting or selling doses _ or resistance can develop in as little as two weeks. If that happens, new viral strains will emerge, making things worse. Yet the dirt bike program and other pilot projects show success is possible. AIDS originated in Africa and has long had its worst impact there. Nearly 30 million Africans have HIV — the population of Wisconsin, New York and Massachusetts combined. Infection rates are as high as 40 percent in some African countries. Nearly 20 million Africans have died of AIDS, and more than 11 million children have lost one or both parents to it. But Africa and its problems seemed remote, and it was hard to see how to solve them. There’s no vaccine to defeat AIDS, and no cure, only expensive drugs that must be taken for a lifetime. However, a new attitude seems to have taken hold: Do what we can in Africa because we no longer can do nothing. In all of Africa, 4.4 million critically need AIDS drugs but fewer than 100,000 get them now. There are three main ways: from an employer, from medical studies like the dirt bike project, or by paying $25 to $30 a month for the cheapest generic drugs available, sold from treatment centers like this one. Now a fourth way is emerging _ programs that give the drugs to the public for free or with a small co-pay. The humanitarian group Doctors Without Borders is doing this in scattered sites around the continent, and the Bill & Melinda Gates Foundation and the Merck Foundation have donated $50 million each to expand a program in Botswana. But these are limited efforts. Doctors Without Borders has about 6,000 people in treatment; the Merck-Gates program aims to treat 100,000, all in one country. To go beyond that, many are looking to Bush and the Global Fund to Fight AIDS, TB and Malaria — an international fund created by private and public donors that’s affiliated with the United Nations, heavily financed by the United States, and headed by health secretary Thompson. When Bush pledged a jaw-dropping $15 billion during his State of the Union speech in 2003, the Kampala clinic’s director, Peter Mugyenyi, stood near him, full of hope. Uganda is Africa’s fairy tale story, having slashed HIV infection rates from 20 percent to 5 percent in a decade, largely because its leaders talked frankly about the disease and pushed testing and prevention. Mugyenyi hoped Bush’s money would let them do more. But in the year since then, more than 3 million Africans became newly infected with HIV, more than 2 million died, and not a penny of the money has arrived, though Congress recently approved the first $2.4 billion. Mugyenyi is disappointed. “When a genuine emergency comes, we need a quick response. If you commit yourself to helping the problem, you need to commit yourself to making the money available very quickly,” he said. He sees the anguish of the current situation. Walking through his clinic one day, he saw a mother with a 4-year-old child who had advanced AIDS. The mother was getting treatment through a medical study, but there were no drugs for family members. “I thought to myself, `Is there a woman, a mother, who can take treatment by a child?’ ” Mugyenyi said. He ordered the staff to treat the child. He would find the money somewhere.